Neisseria meningitidis

(Meningococcus)
Shyam Kumar Mishra
 Family – Neisseriaceae
Definition:
– Cocci 0.6-1.0 m in diameter, occurring singly but more
often in pairs with adjacent sides flattened;
– capsules and fimbriae may be present;
– endospores (–);
– gram-negative aerobes;
– aflagellate;
– some are nutritionally fastidious;
– oxidase and catalase (+),
– optimum temp. for growth 35-370C
– G+C content of DNA 46.5-53.5%
 History

Diplococcus intracellularis meningitidis

First described and isolated by Weichselbaum (1887)

from CSF
 Morphology
Gram-negative
Oval or spherical cocci
0.6-0.8 m
Arranged in pairs with the adjacent
sides flattened; generally intracellular
Capsulated
Atrichate
 Cultural requirements
Media enriched with blood, serum
Media
Blood agar,
Strict aerobes Chocolate agar,
MHA,
35-360C (no growth <300C) Modified
Thayer-Martin
media (with
Optimal pH 7.4 – 7.6
vancomycin,
colistin and
5-10% CO2 and high humidity nystatin)
 Cultural characteristics
Enriched solid media- (24hrs) – small, translucent,
round, convex, bluish grey with a smooth glistening
surface
• Butyrous and easily emulsifiable
• Weak haemolysis (Blood agar)
• S and R types of colonies are found

Liquid media- Poor growth (granular turbidity with little

or no surface growth)
 Biochemical reactions
Oxidase +
Catalase +
Glucose + (acid only)
Maltose + (acid only)
Lactose –
Sucrose –
Fructose –
Gamma-glutamylaminopeptidase +
 Antigenic properties and
classification
Based on capsular polysaccharide- 12
serogroups (A, B, C, X, Y, Z, 29E, W-135, H,
I, K, L)
(A,B,C most important)

Serogroups (12) >> Serotypes (20) >>

Subserotypes (10) >> Immunotypes (12)
(based on OMPs, and Polysaccharides)
 Pathogenicity

– Pili-mediated, receptor-specific colonization

cells of nasopharynx

– Antiphagocytic polysaccharide capsule allows

systemic spread in absence of specific immunity

– Toxic effects mediated by hyperproduction of

lipooligosaccharide

– IgA protease
 Diseases associated with N.
meningitidis
Following dissemination of virulent organisms
from the nasopharynx:
– Meningitis
– Septicemia (meningococcemia) with or
without meningitis
– Meningoencephalitis
– Pneumonia
– Arthritis
Pathogenesis of meningococcal disease

via
bloodstream,
Or, along the
perineural
sheath of the
olfactory nerve,
Or, through
conjunctiva
 Pathophysiology
Exposure to the pathogen
Mucosal Invasion (endocytosis)
Meningeal Invasion (fimbrial phase variation to
cross the Brain-Blood barrier)
Disruption of BBB
 Hyperproduction of endotoxin
 Hyperproduction of endotoxin (lipid A of LOS) and
blebbing into surrounding environment (e.g.,
subepithelial spaces, bloodstream) mediates most
clinical manifestations including

diffuse vascular damage (e.g., endothelial

damage),
vasculitis (inflammation of vessel walls),
thrombosis (clotting),
disseminated intravascular coagulation (DIC)
 Meningococcemia
Acute fever with chills, malaise and
prostration
Petechial rash occurs
Metastatic involvement of other joints, ears,
eyes, lungs and adrenals
Fulminant meningococcemia
(Waterhouse-Friderichsen syndrome)
 Epidemiology
Only natural reservoir: human nasopharyngeal
mucosa
~ 10% average nasal carrier rate
- rate may be as high as 90% in some populations
Transferred via droplets or direct contact
Common in children between 3 months to 5 years of
age.
Also common in people living in crowded conditions
(jails, army camps, school)
 Laboratory diagnosis

Delicate organisms

(No refrigeration of samples)

Laboratory diagnosis
Examination of CSF
Blood culture
Nasopharyngeal swab
Petechial lesions
Autopsy
Retrospective evidence
Molecular methods
 Treatment
Prompt treatment
A third-generation cephalosporin- cefotaxime (2 g iv
every 4 h) or ceftriaxone (2 g iv every 12 h), is
preferred for initial therapy.

Other option include meropenem (1 g iv every 8 h).

(Many strains resistant to penicillin and sulfonamides)

 Vaccination
Quadrivalent vaccine containing serogroups A, C, Y, and
W135 is effective in people older than 2 years of age for
immunoprophylaxis as an adjunct to chemoprophylaxis